Managing oligoprogressive malignant pleural mesothelioma with stereotactic body radiation therapy

Our plain-English summary of Managing oligoprogressive malignant pleural mesothelioma with stereotactic body radiation therapy, by A.R. Barsky, N. Yegya-Raman, S.I. Katz, et al (Lung Cancer, 2021).

The study

• Authors: A.R. Barsky, N. Yegya-Raman, S.I. Katz, C.B. Simone, K.A. Cengel
• Journal: Lung Cancer
• Published: 2021;157:163-164
• Type of article: Letter, Comment
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this letter, the authors responded to a multi-institutional study by Ghirardelli et al. of hypofractionated focal radiotherapy for oligoprogressive malignant pleural mesothelioma (MPM). That study reported 6- and 12-month local control (LC) rates of 84% and 76%, which the authors noted were lower than rates reported for stereotactic body radiation therapy (SBRT) in non-small cell lung cancer and lung metastases. They reviewed their own unpublished institutional series. Fifteen patients with histologically confirmed MPM were treated between 2012 and 2020 with pleural SBRT to 25 lesions for oligoprogressive disease after systemic therapy with or without surgery. Most were male (80%), all were Caucasian, and 87% had epithelioid histology. Median age was 68 years. The median prescribed dose was 40 Gy (range 30–50 Gy) in 5 fractions. At a median follow-up of 13.2 months there were two local failures, at 34.9 and 39.5 months. LC rates at 6, 12, 24, 36 and 48 months were 100%, 100%, 100%, 87.5% and 75%. Median time to further systemic therapy was 10.9 months, and there were no Grade 3 or higher SBRT-related toxicities. The authors suggested that the lower LC in other series was likely due to treatments with lower biologically effective dose (BED). Larger tumours or different later therapies may also have contributed. They concluded that pleural SBRT can achieve durable LC without appreciable toxicity, and they advocated high-BED SBRT within organ-at-risk tolerances.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This letter responds to a study by Ghirardelli and colleagues on radiotherapy for oligoprogressive malignant pleural mesothelioma (disease progressing at only a few sites). The authors described their unpublished series of 15 patients treated between 2012 and 2020 with stereotactic body radiation therapy (SBRT) to 25 pleural lesions after drug therapy, with or without surgery. Most were male (80%) with epithelioid tumors (87%). Median dose was 40 Gy, usually in 5 sessions. Over a median 13.2 months of follow-up, control was lost at two treated sites (local failure), at 34.9 and 39.5 months. Local control was 100% at 6, 12 and 24 months, 87.5% at 36 and 75% at 48. Median time to further drug therapy was 10.9 months (95% CI 5.7 to 27.8). No Grade 3 or higher radiation side effects occurred. The authors judged lower biologically effective dose (BED) the likely reason for lower control in Ghirardelli's and another study. They also raised tumor size and later drug treatment as possible explanations. They concluded that pleural SBRT can give durable control without appreciable added toxicity. They advocated high-BED SBRT within organ-at-risk tolerances and lung SBRT guidelines.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Letter to the editor reporting the authors' own unpublished single-institution case series (retrospective review)
• Who was studied: 15 patients with histologically confirmed malignant pleural mesothelioma, 25 lesions, treated 2012 to 2020 at the authors' institution (authors listed at the Hospital of the University of Pennsylvania, Philadelphia). 80% male, 100% Caucasian, 87% epithelioid, median age 68 (range 57 to 83).
• Exposure: No asbestos exposure is reported. The factor studied was a treatment: pleural stereotactic body radiation therapy for oligoprogressive disease after systemic therapy with or without surgery. The median dose was 40 Gy (range 30 to 50 Gy) in 5 fractions (range 4 to 5).
• Main results:
  • Median follow-up for the entire cohort was 13.2 months (range 0.7 to 55.7 months)
  • Two local failures occurred, at 34.9 and 39.5 months after the start of SBRT
  • Local control rates in this series were 100% at 6, 12 and 24 months, 87.5% at 36 months and 75% at 48 months
  • Median time to further systemic therapy was 10.9 months (95% CI 5.7 to 27.8 months)
  • There were no acute or late Grade 3 or higher SBRT-related toxicities
• The authors' conclusion: The authors suggested that the lower local control in the Ghirardelli and Schröder series was likely due to lower-BED treatments. They also raised smaller tumor size and differences in subsequent systemic therapy as possible explanations. Based on Ghirardelli et al., Schröder et al. and their own data, they concluded that pleural SBRT can achieve durable local control and delay subsequent therapy without appreciable added toxicity. They advocated high-BED SBRT that closely respects organ-at-risk tolerances and follows lung SBRT guidelines.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Stereotactic Body Radiation Therapy (SBRT), Non-Small Cell Lung Cancer, Systemic Therapy, Epithelioid, Histology.

Related studies

• A reply to "managing oligoprogressive malignant pleural mesothelioma with stereotactic body radiation therapy" — G.L. Ceresoli, P. Ghirardelli, et al. (2021)
• A Novel Prospective Study Assessing the Combination of Photodynamic Therapy and Proton Radiation Therapy: Safety and Outcomes When Treating Malignant Pleural Mesothelioma — S.R. Rice, Y.R. Li, et al. (2019)
• Disease-Related Outcomes and Toxicities of Intensity Modulated Radiation Therapy After Lung-Sparing Pleurectomy for Malignant Pleural Mesothelioma: A Systematic Review — R. Patel, E.B. Ludmir, et al. (2020)
• Cyberknife radiosurgery for focal paravertebral recurrence after radical pleurectomy/decortication in malignant pleural mesothelioma — L. Lang-Lazdunski, S. Barrington, et al. (2012)
• The Use of Radiation Therapy for the Treatment of Malignant Pleural Mesothelioma: Expert Opinion from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation — D.R. Gomez, A. Rimner, et al. (2019)
• First-ever Abscopal Effect after Palliative Radiotherapy and Immuno-gene Therapy for Malignant Pleural Mesothelioma — A.R. Barsky, K.A. Cengel, et al. (2019)

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